Dr. Aderonke Agbaje is the Director of Programmes -Special Projects of the Institute of Human Virology Nigeria (IHVN). Agbaje who is also the Chief of Party of the USAID TB-LON 3 Project in this interview, spoke about the burden of tuberculosis in Nigeria, the implementation of the new Global Fund To Fight AIDS, Tuberculosis And Malaria Grant Cycle 7 (GC7), and how IHVN will lead the TB-HIV integration component in tackling the diseases, among others.
Can you briefly tell us about the prevalence of tuberculosis in Nigeria?
The latest estimates show that 219 out of every 100,000 Nigerians have tuberculosis, and each person with tuberculosis could infect 12-14 close contacts in a year.
IHVN is one of the principal recipients of the Global Fund grant cycle 7 (GC7). How will it help in tackling the diseases in the country?
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The GC7 grant will extend TB and Prevention of Mother to Child Transmissions (PMTCT) services to 36 states and the Federal Capital Territory (FCT), support comprehensive HIV services in four states, and malaria services in 13 states.
The grant will also support the update and dissemination of policy documents across various ministries, departments, and agencies to improve the quality of health of Nigerians. IHVN is the Principal Recipient of the TB/HIV integration component of the grant.
What this component seeks to do is to streamline TB and HIV health service provision to Nigerians, especially in the private sector and at the community level. It will also include general health wrap-around services.
What used to happen in the past is that when we take health services to Community A, for example, we conduct TB screening for Community A and leave. Another group comes and conducts HIV testing for community A and leaves. Another group comes and provides malaria services for community A and leaves. What IHVN is supporting the government of Nigeria to do with this integration is that when we go to community A, we provide minimal services for HIV, TB, malaria, high blood pressure, diabetes, etc. before referring them for higher services.
With this, we can save more funds and make a greater impact because we reduce the number of people participating in repetitive services.
Again, we are also reducing the burden on the healthcare workers that we are partnering with in providing these services. They can go just once and do all they have to do in that community. This increases the impact of our intervention; it makes us more efficient in implementation.
Another important thing about this integration grant is that it is the first of its kind. For the first time, both TB and HIV services are going to be provided nationally. Every single state will get support to provide minimal TB and HIV services at the community level.
For the previous GC6 grant, we had TB services in the community in just about 12 states, and we had HIV services, testing pregnant women just in a few states. We had TB services in the private sector just happening in about 22 states.
For the first time, all these services I mentioned are going to be offered in the 36 +1 states. This gives Nigerians an opportunity to include other wraparound services. It means we are checking their blood pressure and blood sugar. These are things that can cause mortality beyond tuberculosis and HIV.
One thing I would like to add is that this grant is big on prevention. We are not just going to sit down and wait for people to come with these diseases. We are looking at the measures we are going to put in place to prevent them. Once you put in prevention interventions, it reduces the number of people falling ill and the resources that go into managing the diseases. Then, we would have a healthier, stronger, productive workforce.
We will be looking at the prevention of tuberculosis and HIV for both the general population and key populations e.g. screening of all pregnant women for TB and testing for HIV. Key populations are now known to be major drivers of the disease. There are a lot of prevention components that are coming in through the Global Fund GC7 TB-HIV integration grant.
How is the partnership from federal level to community engagements toward ensuring the success of the grant?
The partnership for this TB-HIV integration grant that IHVN is leading is diverse. Right from the community level, the community volunteers, the community-based organisations, and the local government health providers at the state level where we have the sub-recipients, we have about 12 partners that will be working with IHVN to implement this grant. We have those sub-recipients across the 36 + 1 states. We have the state ministries of health, and the integration agenda is primarily domiciled in the Directorate of Public Health.
We are also working with the various ministries and agencies at the national level.
In summary, we have partnerships across community-based organisations, civil society, and the government at all levels.
Are there accountability mechanisms to ensure judicious use of the funds?
Yes, let me start from the community level. In addition to the service provision angle of the grant, there is a health system strengthening arm as part of the portfolio. In the health system strengthening arm, there are various government agencies that we are accountable to.
Also at the community level, the community members, and civil society demand accountability. First, we build their capacity to know what to expect. This is the minimum expectation when we take community services to them or when they go to the health facility to receive services. They already have their capacities built to know what to expect and demand accountability. That way, they are monitoring the services that are being provided to their network, and their community members and they can report on that.
They are also able to liaise with the technical support providers and the sub-recipients. We have created that linkage where they relate directly with them to look at what the gaps are and how the gaps can be filled. We work together at the national level to make sure that we are providing the highest level of quality care to Nigerians.
At the community level, we have that community-led monitoring component, and this is what we have across the country, anchored by the TB network, which is a conglomerate of TB civil societies (TBN), Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) and the Civil Society for Malaria Control, Immunization and Nutrition (ACOMIN).
Then, of course, at the state level, the integration is domiciled at the Directorate of Public Health. So, at the highest level of the state, up to the level of the commissioner of health and the governor, there will be accountability for the quality of services that are given through this project.
In addition to that, there is the Country Coordinating Mechanism of the Global Fund, and they have various components of that coordinating mechanism that demand accountability for service provision, for the quality of data being reported, and how dependable it is for the country to make decisions with. They also follow the money.
Global Fund also has various assurance providers because there are so many layers and so many levels of implementation and they also must report that resources are being used judiciously. These include external auditors, internal auditors, and Local Fund Agents (LFA). For Nigeria, it is PricewaterhouseCoopers International Limited. These are standard assurance mechanisms that the Global Fund has put in place globally. We also have them in Nigeria, monitoring the judicious use of resources and ensuring that people are receiving the quality care and services that they deserve.
As you commence the implementation of this grant, what is your advice to Nigerians when it comes to TB, Malaria, and HIV?
Nigerians should be health conscious. Through the support of donors and the government of Nigeria, we are putting out a lot of information, education, and communication about the triggers, and the symptoms to watch out for.
The government continues to scale up capacity in hospitals, both public and private to attend to Nigerians wherever they are.
The government and the donors have also collaborated to make these services, at least for TB, HIV, and malaria, free for Nigerians. Please go and access these services as needed and if you are having difficulty knowing where to go, they can contact their state ministries of health, and local government area departments of health.
